Crisis in U.S. Health Care: Corporate Power Still Blocks Reform

Abstract

The corporate, largely privatized market-based U.S. health care system is deteriorating in terms of increasing costs, decreasing access, unacceptable quality of care, inequities, and disparities. Reform efforts to establish universal insurance coverage have failed on six occasions over the last century, largely through opposition of corporate stakeholders in the medical-industrial complex. This article provides historical perspective to previous reform attempts, updates the current battle between Republicans and Democrats over repeal of the 2010 Affordable Care Act (ACA), and compares three financing alternatives—continuation of the ACA; its replacement by a Republican plan (the House’s American Health Care Act or its Senate counterpart, the Better Care Reconciliation Act); and single-payer national health insurance (NHI or Medicare for All). Markers are described that reveal the extent of the current crisis in U.S. health care. Evidence is presented that the private insurance industry, increasingly dependent on bailout by the government, is in a “death spiral.” NHI is gaining increasing public support as the only financing alternative to provide universal coverage. Nine lessons that are still unlearned in the United States concerning health care are discussed, together with future prospects to establish universal coverage in this embattled and changing political environment.